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Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists
  1. J Askling1,2,
  2. C M Fored1,
  3. L Brandt1,
  4. E Baecklund3,
  5. L Bertilsson4,
  6. N Feltelius2,5,
  7. L Cöster6,
  8. P Geborek7,
  9. L T Jacobsson8,
  10. S Lindblad2,
  11. J Lysholm9,
  12. S Rantapää-Dahlqvist10,
  13. T Saxne7,
  14. L Klareskog2
  1. 1Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
  2. 2Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
  3. 3Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
  4. 4Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
  5. 5Medical Products Agency, Uppsala, Sweden
  6. 6Department of Rheumatology, Linköping University Hospital, Linköping, Sweden
  7. 7Department of Rheumatology, Lund University Hospital, Lund, Sweden
  8. 8Department of Rheumatology, Malmö University Hospital, Malmö, Sweden
  9. 9Department of Rheumatology, Falu County Hospital, Falun, Sweden
  10. 10Department of Rheumatology, University Hospital, Umeå, Sweden
  1. Correspondence to:
    Dr J Askling
    Clinical Epidemiology Unit M9:01, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden;


Background: Existing studies of solid cancers in rheumatoid arthritis (RA) reflect cancer morbidity up until the early 1990s in prevalent cohorts admitted to hospital during the 1980s.

Objective: To depict the cancer pattern of contemporary patients with RA, from updated risk data from prevalent and incident RA populations. To understand the risk of solid cancer after tumour necrosis factor (TNF) treatment by obtaining cancer data from cohorts treated in routine care rather than trials.

Methods: A population based study of three RA cohorts (one prevalent, admitted to hospital 1990–2003 (n = 53 067), one incident, diagnosed 1995–2003 (n = 3703), and one treated with TNF antagonists 1999–2003 (n = 4160)), which were linked with Swedish nationwide cancer and census registers and followed up for cancer occurrence through 2003.

Results: With 3379 observed cancers, the prevalent RA cohort was at marginally increased overall risk of solid cancer, with 20–50% increased risks for smoke related cancers and +70% increased risk for non-melanoma skin cancer, but decreased risk for breast (−20%) and colorectal cancer (−25%). With 138 cancers, the incident RA cohort displayed a similar cancer pattern apart from non-decreased risks for colorectal cancer. TNF antagonist treated patients displayed solid cancer (n = 67) risks largely similar to those of other patients with RA.

Conclusion: The cancer pattern in patients treated with TNF antagonists mirrors those of other contemporary as well as historic RA cohorts. The consistent increase in smoking associated cancers in patients with RA emphasises the potential for smoking cessation as a cancer preventive measure in RA.

  • NRN, national registration number
  • NSAID, non-steroidal anti-inflammatory drug
  • RA, rheumatoid arthritis
  • SIR, standardised incidence ratio
  • TNF, tumour necrosis factor
  • cancer
  • risk
  • rheumatoid arthritis
  • epidemiology
  • Sweden
  • tumour necrosis factor

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  • Published Online First 13 April 2005